A 10-minute educational video for aged-care staff could help pave the way to better understanding about nutrition and enriching diets for older adults with dementia.
That’s the goal of MENU – a project to promote Meaningful Engagement in Nutritional Understanding and improved care for people living with dementia, with staff as agents of change.
Dr Emma Lea, a researcher at the University of Tasmania, is leading the study to address malnutrition, a silent epidemic that afflicts around half of older Australians in nursing homes.
The project is part of a broader spotlight on aged care, sparked by revelations of appalling conditions in residential facilities including low food budgets, poor quality diets, understaffing and ineffective feeding practices.
People with dementia are particularly prone to malnutrition and dehydration and have special needs to ensure adequate food and drink intake.
Defining the problem
Lea’s team first collected data about obstacles to nutrition care through documents, resident files, observations of seven residents with dementia and interviews with family and staff members.
They identified five key barriers.
Most basically, body mass index was not measured to identify underweight residents. Staff also knew little about how nutrition is related to clinical health indicators such as healing wounds and warding off disease.
Although staff were attentive, their attempts to encourage residents to eat were ineffective. This was compounded by a dearth of meal choices and the perception that eating is a chore rather than a pleasurable event.
As the survey revealed, tackling malnutrition in older adults is in dire need of attention to the complexities involved in eating well.
The next step is a two-year study in two aged care facilities in Tasmania to promote nutritional strategies, in which Lea’s team is working closely with staff to put effective nutrition and eating practices in place, seeking staff feedback along the way.
Strategies include doing more to help residents eat, like positioning drinks within reach, offering snacks throughout the day and improving the quality of the food and the eating environment.
These insights came from nurses themselves during the pilot study.
One said, for instance, “The tea menu is appalling and needs a major overhaul… [it] is quite inappropriate for elderly people; party pies, sausage rolls, wedges, deep fried food, pikelets, jam and cream are not a satisfactory evening meal.”
Others highlighted the need to keep snacks available and continually offer drinks to promote hydration.
Another understood the importance of environment. “Quite a significant number of staff don’t understand that social interaction that’s needed with food and that’s why you have people [staff] around having some social conversation instead of interacting with the resident.”
“Good nutrition is about more than just the nutritional content of food, it’s about the whole food experience like the dining room setting, the environment and social interaction,” Lea told Australian Ageing Agenda.
The project also emphasises the importance of staff involvement and empowerment to drive change.
“I’m hoping that by engaging staff, it will sustain change and that if we can fine tune this model, we can get it out there and maybe other aged care homes can implement similar models.”
“There is an importance of getting staff to be engaged so they feel empowered to make change and ensure it is sustainable.”